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The Jackson, Mississippi, water crisis this summer is a troubling reminder that some American communities are still failing to provide safe water to their residents. After Jackson’s primary water treatment plant failed, around 180,000 people were left with little or no sanitary water. It was reminiscent of the crisis in Flint, Michigan, which rose to broad public awareness in 2015, when residents learned that they’d been poisoned for months by drinking water containing bacteria, disinfectant byproducts, and lead.

The crisis is far from a distant memory in Flint. According to a new survey of nearly 2,000 adult community members published in JAMA Network Open on Sept. 20, residents were still struggling from the enduring mental health impact of the crisis, five years later. After conducting a survey from 2019 to 2020, the researchers estimated that in the year before the survey, about one in five Flint residents presumptively experienced major depression, while a quarter had PTSD, and one in 10 had both illnesses. Those who believed that they or their families were hurt by the contaminated water were significantly more likely to be affected. The authors note that lead itself can impact mental health, including mood.
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Flint residents, who are largely low-income and people of color, were already vulnerable to mental-health issues, including because of systemic racism, a shortage of quality affordable housing, and widespread poverty. However, the researchers found evidence that the water crisis itself had a lasting mental health impact. For instance, 41% of respondents said they’d felt mental or emotional problems related to their concerns about water contamination. Flint residents were more than twice as likely to have had major depression compared to the general population rate in Michigan, U.S., or the world, and were twice as likely to have PTSD compared to veterans after deployment, according to the study.

The way the water crisis unfolded made Flint residents particularly vulnerable to long-term mental-health effects, the researchers say. One major problem is that public officials’ decisions caused the water crisis in 2014, when they switched the city to untreated water from the Flint River. Even after health care workers raised alarms about high levels of lead in children’s blood, officials misled the public by insisting that the water was safe. “Feelings that the community is not being looked after, or it’s in fact being abandoned, add an additional layer of stress,” says Aaron Reuben, a co-author of the new study and postdoctoral scholar at Duke University and the Medical University of South Carolina.

A lack of resources can also compound anxiety. Lottie Ferguson, the chief resilience officer for the City of Flint, noted that food insecurity made it harder for residents to eat a healthy diet rich with foods that mitigate the effects of lead toxicity. Ferguson, who worked in Flint during the crisis and whose children were exposed to lead, says that she felt for parents who didn’t have the same resources as her family. “I was more upset and more hurt for parents who didn’t have access to resources to ensure the futures of their children,” she says, adding that she understands why mistrust of officials is still common in Flint.

Also complicating the situation: the water crisis dragged on for a long period of time. Although the water supply was switched back to its original source in October 2015, lead levels didn’t drop below the federal limit until January 2017. That’s left Flint residents with a lasting sense of uncertainty about their health and safety. “It wasn’t like a hurricane that came and went, and then you rebuild,” says Lauren Tompkins, the former vice president of clinical operations at Genesee Health System, a nonprofit health care organization in Flint. She coordinated the emergency mental health resources available to residents in response to the crisis. “The pipes took quite some number of years to fix. So you’re just constantly in this state, for a long period of time, of worrying.”

In many ways, the water crisis has yet to end. For instance, researchers have described a rise in hyperactivity and learning delays among children. Residents still don’t know for sure how deeply they and their families were affected by the polluted water, and whether it triggered health problems they’re experiencing now. They also don’t know if new health issues will suddenly appear in the future.

That’s similar to what happened after the partial meltdown at Three Mile Island nuclear plant in Pennsylvania in 1979, says study co-author Dean G. Kilpatrick, a professor of psychiatry at the Medical University of South Carolina, who researches PTSD and traumatic events. Although locals weren’t exposed to dangerous levels of radiation, the fear that they would be led to lasting mental health harm. “If something’s invisible, tasteless, you can’t really tell if you’ve got it or not,” says Kilpatrick. “Even the perception that you might have been exposed to something, in and of itself, is sufficient to drive a lot of long-term mental-health effects.”

With the help of outside funding and assistance, Flint community members expanded mental-health offerings in Flint, both during the initial crisis and the years that followed. However, only 34.8% of respondents said they were offered mental-health services for symptoms related to the crisis, although 79.3% of those who were offered services took advantage of them. The study’s authors argue that their findings indicate Flint still needs a greater mental health response from the local, state, and federal government. There are also important lessons for other cities enduring water crises, including Jackson—such as how important it is to provide the public with clear, accurate information.

Overall, says Reuben, it’s essential to recognize that crises like what happened in Flint can have an enduring impact on mental health. In Jackson, “We want the community to know we’re thinking about them, and we’re going to think about their mental health,” he says. “Not just once the taps run clear, but potentially for years after.”

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